Food Worker Card Fee Refund Request

Directions

Complete all required fields and submit the form.

Questions?

Please contact the Food Worker Card coordinator at decfwc@alaska.gov.

Name*

First NameLast Name

Phone Number*

Email*

Confirmation Emailgwashington@email.com

Test ID*

Invoice Number*

Please explain why you are requesting a refund of the food worker card fee.*

Refund Amount Requested*

Other Refund Amount

Type the refund amount requested.

Mailing Address for Refund Check*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Certification

I hereby request the refund listed above and I declare, under penalty of unsworn falsification, that this application (including any accompanying statements) has been examined by me and to the best of my knowledge and belief is true, correct, and complete.

Please verify that you are human.*